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Krueger C, Nguyen ELV, Mahant S, Borkhoff CM, Cichon J, Drouin O, Pound C, Quet J, Wahi G, Bayliss A, Vomiero G, Foulds J, Kanani R, Sakran M, Sehgal A, Pullenayegum E, Widjaja E, Reginald A, Wolter N, Parkin P, Gill PJ. Association of empiric antibiotic selection and clinical outcomes in hospitalised children with severe orbital infections: a retrospective cohort study. Arch Dis Child 2024:archdischild-2023-326175. [PMID: 38589203 DOI: 10.1136/archdischild-2023-326175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/27/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE To determine the association of initial empiric antibiotic regimens with clinical outcomes in hospitalised children with severe orbital infections. DESIGN Multi-centre observational cohort study using data from 2009 to 2018 clinical records. SETTING Canadian children's hospitals (7) and community hospitals (3). PATIENTS Children between 2 months and 18 years hospitalised for >24 hours with severe orbital infections. INTERVENTIONS Empiric intravenous antibiotic regimen in the first 24 hours of hospitalisation. MAIN OUTCOME MEASURES Length of hospital stay and surgical intervention using multivariable median regression and multivariate logistic regression, with adjustment for covariates. RESULTS Of 1421 patients, 60.0% were male and the median age was 5.5 years (IQR 2.4-9.9). Median length of stay was 86.4 hours (IQR 56.9-137.5) and 180 (12.7%) received surgical intervention. Patients receiving broad-spectrum empiric antibiotics had an increased median length of stay, ranging from an additional 13.8 hours (third generation cephalosporin and anaerobic coverage) to 19.5 hours (third generation cephalosporin, staphylococcal and anaerobic coverage). No antibiotic regimen was associated with a change in the odds of surgical intervention. These findings remained unchanged in sensitivity analyses restricted to more severely ill patients. There was a twofold increase in the percentage of patients receiving the broadest empiric antibiotic regimens containing both staphylococcal and anaerobic coverage from 17.8% in 2009 to 40.3% in 2018. CONCLUSIONS Empiric use of broad-spectrum antibiotics with staphylococci and anaerobic coverage was associated with longer length of stay and similar rates of surgery in children with orbital infections. There is an urgent need for comparative effectiveness studies of various antibiotic regimes.
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Affiliation(s)
| | | | - Sanjay Mahant
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jessica Cichon
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Olivier Drouin
- Division of General Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Quebec, Canada
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Catherine Pound
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Julie Quet
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Gita Wahi
- Department of Pediatrics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Ann Bayliss
- Department of Pediatrics, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Gemma Vomiero
- Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Jessica Foulds
- Stollery Children's Hospital, Edmonton, Alberta, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Ronik Kanani
- North York General Hospital, Toronto, Ontario, Canada
| | | | - Anupam Sehgal
- Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Elysa Widjaja
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Arun Reginald
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus Wolter
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Parkin
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Peter J Gill
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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2
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Yama B, Wahi G, Zhou K, Bayliss A, Sakran M, Breen-Reid K, Pound C, Beck C, Friedman J, Arafeh D, Kanani R, Parkin P, Mahant S. De-implementing low-value continuous pulse oximetry practice in infants hospitalized with bronchiolitis: A multicentre qualitative study. J Hosp Med 2023; 18:1092-1101. [PMID: 37932871 DOI: 10.1002/jhm.13236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/07/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Clinical trial evidence supports the routine use of intermittent pulse oximetry in stabilized infants hospitalized with bronchiolitis. However, continuous pulse oximetry use is common. OBJECTIVE This study aimed to understand the barriers and facilitators to de-implement continuous pulse oximetry and implement intermittent pulse oximetry in infants hospitalized with stabilized bronchiolitis. METHODS This multicentre qualitative study interviewed attending pediatricians, residents, nurses, respiratory therapists, and caregivers of infants hospitalized with bronchiolitis at hospitals in Ontario, Canada, to explore beliefs, attitudes, and experiences regarding pulse oximetry use in bronchiolitis management. Data were analyzed using thematic analysis to understand barriers and facilitators to practice change, mapped to the Consolidated Framework for Implementation Research (CFIR) domains. RESULTS Sixty-seven participants from six hospitals were interviewed using individual interviews and focus groups. Healthcare providers emphasized the importance of identifying and understanding who is responsible for bedside pulse oximetry practice (physicians vs. nurses). Clinical experience, knowledge of guidelines, importance versus competing priorities, and the tensions among team members due to practice variation in monitoring, influenced monitoring practice. Nurses believed in the advantages of intermittent monitoring (reduced alarm fatigue, facilitation of timely discharges, and reduced workload). Clinicians identified ways to clarify indications for continuous monitoring (based on patient risk factors), versus indications to transition to intermittent monitoring (established oral feeding, sleeping without desaturations). Caregivers did not express a clear preference for monitoring type; rather, they described the need for clear communication around interpreting monitor readings, management decisions, and care transitions. CONCLUSIONS Understanding professional roles, clarity around local practice standards and supporting families' understanding of pulse oximetry practice is essential for practice change. These findings may inform hospital quality improvement efforts to de-implement continuous monitoring in bronchiolitis hospital care.
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Affiliation(s)
- Brie Yama
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gita Wahi
- Department of Pediatrics, Division of General Pediatrics, McMaster University and McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Kim Zhou
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, North York General Hospital, Toronto, Ontario, Canada
| | - Ann Bayliss
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Children's Health Division, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Mahmoud Sakran
- Department of Pediatrics, Lakeridge Health, Oshawa, and Queen's University, Kingston, Ontario, Canada
| | - Karen Breen-Reid
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Pound
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Carolyn Beck
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jeremy Friedman
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dana Arafeh
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ronik Kanani
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, North York General Hospital, Toronto, Ontario, Canada
| | - Patricia Parkin
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sanjay Mahant
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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3
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McKerlie MF, Wolter NE, Mahant S, Cichon J, Widjaja E, Drouin O, Pound C, Quet J, Wahi G, Bayliss A, Vomiero G, Foulds JL, Kanani R, Sakran M, Sehgal A, Borkhoff CM, Pullenayegum E, Reginald A, Parkin PC, Gill PJ. Abscess volume as a predictor of surgical intervention in children hospitalized with orbital cellulitis: A multicentre cohort study. Int J Pediatr Otorhinolaryngol 2023; 171:111629. [PMID: 37437497 DOI: 10.1016/j.ijporl.2023.111629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 07/14/2023]
Abstract
IMPORTANCE Orbital cellulitis with subperiosteal or orbital abscess can result in serious morbidity and mortality in children. Objective volume criterion measurement on cross-sectional imaging is a useful clinical tool to identify patients with abscess who may require surgical drainage. OBJECTIVE To determine the predictive value of abscess volume and the optimal volume cut-point for surgical intervention. DESIGN We conducted an observational cohort study using medical records from children hospitalized between 2009 and 2018. SETTING Multicentre study using data from 6 children's hospitals. PARTICIPANTS Children were included if they were between 2 months and 18 years of age and hospitalized for an orbital infection with an abscess confirmed on cross-sectional imaging. EXPOSURE Subperiosteal or orbital abscess volume. MAIN OUTCOME AND MEASURES The primary outcome was surgical intervention, defined as subperiosteal and/or orbital abscess drainage. Multivariable logistic regression was performed to assess the association of abscess volume with surgery. To determine the optimal abscess volume cut-point, receiver operating characteristic (ROC) analysis was performed using the Youden Index to optimize sensitivity and specificity. RESULTS Of the 150 participants (mean [SD] age, 8.5 [4.5] years), 68 (45.3%) underwent surgical intervention. On multivariable analysis, larger abscess volume and non-medial abscess location were associated with surgical intervention (abscess volume: adjusted odds ratio [aOR], 1.46; 95% CI, 1.11-1.93; abscess location: aOR, 3.46; 95% CI, 1.4-8.58). ROC analysis demonstrated an optimal abscess volume cut-point of 1.18 mL [AUC: 0.75 (95% CI 0.67-0.83) sensitivity: 66%; specificity: 79%]. CONCLUSIONS AND RELEVANCE: In this multicentre cohort study of 150 children with subperiosteal or orbital abscess, larger abscess volume and non-medial abscess location were significant predictors of surgical intervention. Children with abscesses >1.18 mL should be considered for surgery.
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Affiliation(s)
- Morgyn F McKerlie
- Queens School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Nikolaus E Wolter
- The Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Sanjay Mahant
- The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jessica Cichon
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
| | - Elysa Widjaja
- The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Olivier Drouin
- Department of Pediatrics, Université de Montreal, Montreal, QC, Canada; Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Catherine Pound
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
| | - Julie Quet
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
| | - Gita Wahi
- Department of Pediatrics, McMaster University, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Ann Bayliss
- Trillium Health Partners, Department of Paediatrics, University of Toronto, Mississauga, ON, Canada
| | - Gemma Vomiero
- Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada
| | - Jessica L Foulds
- Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Ronik Kanani
- North York General Hospital, University of Toronto, Toronto, ON, Canada
| | - Mahmoud Sakran
- Department of Paediatrics, Queens University, Lakeridge Health, Oshawa, ON, Canada; Research, Lakeridge Health, Oshawa, ON, Canada
| | - Anupam Sehgal
- Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - Cornelia M Borkhoff
- The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Arun Reginald
- The Hospital for Sick Children, Toronto, ON, Canada; Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON, Canada
| | - Patricia C Parkin
- The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Peter J Gill
- The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
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4
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Nguyen ELV, Hersi L, Mahant S, Cichon J, Drouin O, Pound C, Quet J, Wahi G, Bayliss A, Vomiero G, Foulds JL, Kanani R, Sakran M, Sehgal A, Borkhoff CM, Pullenayegum E, Widjaja E, Reginald A, Wolter NE, Oni S, Anwar R, Louriachi H, Ge Y, Kirolos N, Patel A, Jasani H, Kornelsen E, Chugh A, Gouda S, Akbaroghli S, McKerlie M, Parkin PC, Gill PJ. Variation in the Management of Hospitalized Children With Orbital Cellulitis Over 10 Years. Hosp Pediatr 2023; 13:375-391. [PMID: 37122049 DOI: 10.1542/hpeds.2022-007006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES No previous study has examined the management of hospitalized children with orbital cellulitis at both children's and community hospitals across multiple sites in Canada. We describe variation and trends over time in diagnostic testing and imaging, adjunctive agents, empiric antibiotics, and surgical intervention in children hospitalized with orbital cellulitis. PATIENTS AND METHODS Multicenter cohort study of 1579 children aged 2 months to 18 years with orbital cellulitis infections admitted to 10 hospitals from 2009 to 2018. We assessed hospital-level variation in the use of diagnostic tests, imaging, antibiotics, adjunctive agents, surgical intervention, and clinical outcomes using X2, Mann-Whitney U, and Kruskal-Wallis tests. The association between clinical management and length of stay was evaluated with median regression analysis with hospital as a fixed effect. RESULTS There were significant differences between children's hospitals in usage of C-reactive protein tests (P < .001), computed tomography scans (P = .004), MRI scans (P = .003), intranasal decongestants (P < .001), intranasal corticosteroids (P < .001), intranasal saline spray (P < .001), and systemic corticosteroids (P < .001). Children's hospital patients had significantly longer length of hospital stay compared with community hospitals (P = .001). After adjustment, diagnostic testing, imaging, and subspecialty consults were associated with longer median length of hospital stay at children's hospitals. From 2009 to 2018, C-reactive protein test usage increased from 28.8% to 73.5% (P < .001), whereas erythrocyte sedimentation rate decreased from 31.5% to 14.1% (P < .001). CONCLUSIONS There was significant variation in diagnostic test usage and treatments, and increases in test usage and medical intervention rates over time despite minimal changes in surgical interventions and length of stay.
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Affiliation(s)
| | - Leo Hersi
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sanjay Mahant
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Departments of Pediatrics
- Institute of Health Policy, Management and Evaluation
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Jessica Cichon
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Olivier Drouin
- Departments of Pediatrics and
- Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Quebec, Canada
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Catherine Pound
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Julie Quet
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Gita Wahi
- Department of Pediatrics, McMaster University, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Ann Bayliss
- Trillium Health Partners, Department of Paediatrics, University of Toronto, Mississauga, Ontario, Canada
| | - Gemma Vomiero
- Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Jessica L Foulds
- Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | | | - Mahmoud Sakran
- Department of Paediatrics, Queens University
- Research, Lakeridge Health, Oshawa, Ontario, Canada
| | - Anupam Sehgal
- Kingston Health Sciences Centre, Queens University, Kingston, Ontario, Canada
| | - Cornelia M Borkhoff
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Departments of Pediatrics
- Institute of Health Policy, Management and Evaluation
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Eleanor Pullenayegum
- Departments of Pediatrics
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Elysa Widjaja
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Departments of Pediatrics
| | - Arun Reginald
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Ophthalmology and Visual Sciences
| | - Nikolaus E Wolter
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Otolaryngology, Head & Neck Surgery
| | - Semipe Oni
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rashid Anwar
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Yipeng Ge
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Nardin Kirolos
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Ashaka Patel
- Department of Pediatrics, McMaster University, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Hardika Jasani
- Trillium Health Partners, Department of Paediatrics, University of Toronto, Mississauga, Ontario, Canada
| | - Emily Kornelsen
- Trillium Health Partners, Department of Paediatrics, University of Toronto, Mississauga, Ontario, Canada
| | - Ashton Chugh
- Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Sandra Gouda
- Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | | | - Morgyn McKerlie
- Kingston Health Sciences Centre, Queens University, Kingston, Ontario, Canada
| | - Patricia C Parkin
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Departments of Pediatrics
- Institute of Health Policy, Management and Evaluation
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Peter J Gill
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Departments of Pediatrics
- Institute of Health Policy, Management and Evaluation
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
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5
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Farrar D, Hepburn CM, Drouin O, El Tal T, Morin MP, Berard R, King M, Thibodeau ML, Baerg K, Beaudoin-Bussières G, Beaufils C, Bennett TL, Benseler S, Chan K, Cyr C, Dahdah N, Donner E, Embree J, Farrell C, Finzi A, Forgie S, Giroux R, Kang K, Lang B, Laxer R, McCrindle B, Orkin J, Papenburg J, Pound C, Price V, Proulx-Gauthier JP, Purewal R, Sadarangani M, Salvadori M, Thibeault R, Top K, Viel-Thériault I, Haddad E, Scuccimarri R, Yeung R, Kakkar F, Morris S. Resource use and disease severity of children hospitalized for COVID-19 versus multisystem inflammatory syndrome in children (MIS-C) in Canada. Can Commun Dis Rep 2023; 49:103-112. [PMID: 38356877 PMCID: PMC10866613 DOI: 10.14745/ccdr.v49i04a03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Background Direct comparisons of paediatric hospitalizations for acute coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C) can inform health system planning. We describe the absolute and relative hospital burden of acute paediatric COVID-19 and MIS-C in Canada. Methods This national prospective study was conducted via the Canadian Paediatric Surveillance Program from March 2020-May 2021. Children younger than 18 years old and hospitalized for acute COVID-19 or MIS-C were included in the analysis. Outcomes included supplemental oxygen (low-flow oxygen or high-flow nasal cannula), ventilation (non-invasive or conventional mechanical), vasopressors, paediatric intensive care unit (PICU) admission, or death. Adjusted risk differences (aRD) and 95% confidence intervals (CI) were calculated to identify factors associated with each diagnosis. Results Overall, we identified 330 children hospitalized for acute COVID-19 (including five deaths) and 208 hospitalized for MIS-C (including zero deaths); PICU admission was required for 49.5% of MIS-C hospitalizations versus 18.2% of acute COVID-19 hospitalizations (aRD 20.3; 95% CI, 9.9-30.8). Resource use differed by age, with children younger than one year hospitalized more often for acute COVID-19 (aRD 43.4% versus MIS-C; 95% CI, 37.7-49.1) and more children 5-11 years hospitalized for MIS-C (aRD 38.9% vs. acute COVID-19; 95% CI, 31.0-46.9). Conclusion While there were more hospitalizations and deaths from acute paediatric COVID-19, MIS-C cases were more severe, requiring more intensive care and vasopressor support. Our findings suggest that both acute COVID-19 and MIS-C should be considered when assessing the overall burden of severe acute respiratory syndrome coronavirus 2 in hospitalized children.
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Affiliation(s)
- Daniel Farrar
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON
| | - Charlotte Moore Hepburn
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Olivier Drouin
- Division of General Paediatrics, Department of Paediatrics, CHU Sainte-Justine, Montréal, QC
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC
| | - Tala El Tal
- Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, ON
| | - Marie-Paule Morin
- Division of Paediatric Rheumatology-Immunology, CHU Sainte-Justine, Department of Paediatrics, University of Montreal, Montréal, QC
| | - Roberta Berard
- Division of Rheumatology, Department of Paediatrics, Children’s Hospital at London Health Sciences Centre, London, ON
| | - Melanie King
- Canadian Paediatric Surveillance Program, Canadian Paediatric Society, Ottawa, ON
| | | | - Krista Baerg
- Department of Paediatrics, University of Saskatchewan, Saskatoon, SK
- Division of General Paediatrics, Jim Pattison Children’s Hospital, Saskatchewan Health Authority, Saskatoon, SK
| | - Guillaume Beaudoin-Bussières
- Centre de Recherche du CHUM et Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC
| | - Camille Beaufils
- Division of Paediatric Rheumatology-Immunology, CHU Sainte-Justine, Department of Paediatrics, University of Montreal, Montréal, QC
| | | | - Susanne Benseler
- Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB
- Division of Rheumatology, Department of Paediatrics, Alberta Children’s Hospital, University of Calgary, Calgary, AB
| | - Kevin Chan
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
- Department of Children’s and Women’s Health, Trillium Health Partners, Mississauga, ON
- Institute for Better Health, Trillium Health Partners, Mississauga, ON
| | - Claude Cyr
- Service de Soins Intensifs Pédiatriques, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC
| | - Nagib Dahdah
- Division of Paediatric Cardiology, CHU Sainte-Justine, Department of Paediatrics, University of Montréal, Montréal, QC
| | - Elizabeth Donner
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
- Division of Neurology, The Hospital for Sick Children, Toronto, ON
| | - Joanne Embree
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, MB
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB
| | - Catherine Farrell
- Division of Paediatric Intensive Care, Department of Paediatrics, CHU Sainte-Justine, Montréal, QC
| | - Andrés Finzi
- Centre de Recherche du CHUM et Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC
| | - Sarah Forgie
- Division of Infectious Diseases, Department of Paediatrics, University of Alberta, Edmonton, AB
- Stollery Children’s Hospital, Edmonton, AB
| | - Ryan Giroux
- Women’s and Children’s Health Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON
| | - Kristopher Kang
- Department of Paediatrics, University of British Columbia, Vancouver, BC
| | - Bianca Lang
- Division of Rheumatology, Department of Paediatrics, Dalhousie University, Halifax, NS
| | - Ronald Laxer
- Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, ON
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
| | - Brian McCrindle
- The Labatt Family Heart Centre, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON
| | - Julia Orkin
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
| | - Jesse Papenburg
- Division of Paediatric Infectious Diseases, Department of Paediatrics, Montreal Children’s Hospital, Montréal, QC
- Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, QC
| | - Catherine Pound
- Division of Consulting Paediatrics, Department of Paediatrics, Children’s Hospital of Eastern Ontario, Ottawa, ON
| | - Victoria Price
- Division of Paediatric Hematology/Oncology, Department of Paediatrics, Dalhousie University, Halifax, NS
| | | | - Rupeena Purewal
- Department of Paediatrics, University of Saskatchewan, Saskatoon, SK
- Division of Paediatric Infectious Diseases, Jim Pattison Children’s Hospital, Saskatchewan Health Authority, Saskatoon, SK
| | - Manish Sadarangani
- Department of Paediatrics, University of British Columbia, Vancouver, BC
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC
| | | | - Roseline Thibeault
- Division of Infectious Diseases, Department of Paediatrics, CHU de Québec-Université Laval, Québec City, QC
| | - Karina Top
- Department of Paediatrics, Dalhousie University, Halifax, NS
| | - Isabelle Viel-Thériault
- Division of Infectious Diseases, Department of Paediatrics, CHU de Québec-Université Laval, Québec City, QC
| | - Elie Haddad
- Division of Paediatric Rheumatology-Immunology, CHU Sainte-Justine, Department of Paediatrics, University of Montreal, Montréal, QC
| | - Rosie Scuccimarri
- Division of Paediatric Rheumatology, Montreal Children’s Hospital and McGill University Health Centre, Montréal, QC
| | - Rae Yeung
- Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, ON
- Cell Biology Program, The Hospital for Sick Children, Toronto, ON
- Department of Immunology and Institute of Medical Science, University of Toronto, Toronto, ON
| | - Fatima Kakkar
- Division of Infectious Diseases, CHU Sainte-Justine, Montréal, QC
| | - Shaun Morris
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON
- Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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Moretti ME, Jegathisawaran J, Wahi G, Bayliss P, Kanani R, Sakran M, Pound C, Parkin P, Mahant S. 78 Cost-effectiveness of intermittent vs. continuous pulse oximetry monitoring in infants hospitalized with stabilized bronchiolitis: A multi-centre clinical trial. Paediatr Child Health 2022. [DOI: 10.1093/pch/pxac100.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Pulse oximetry is a non-invasive technology that is integral to the supportive care of hospitalized infants with bronchiolitis. A multi-centre, randomized trial comparing the effectiveness of intermittent vs. continuous pulse oximetry found similar hospital length of stay and safety outcomes, and greater nursing satisfaction with intermittent monitoring.
Objectives
To evaluate the cost-effectiveness of intermittent vs. continuous pulse oximetry in hospitalized infants with stabilized bronchiolitis.
Design/Methods
Prospective economic evaluation concurrent with a randomized trial (October 2016 to May 2019) using a probabilistic analysis. Infants (n=229) 4 weeks to 24 months hospitalized with bronchiolitis, with or without supplemental oxygen, after stabilization were randomized at six Ontario hospitals (community and children's) to intermittent (every 4 hours) vs. continuous pulse oximetry using an oxygen saturation target of 90% or higher. The main outcome measure for the economic evaluation was cost and incremental costs. The clinical effect measure was length of hospital stay in hours. The cost-effective analysis adopted a societal and health care system perspective and a time horizon from hospitalization to 15 days post-discharge. Patient level direct health care costs and indirect costs were included. Costs, health resource use and clinical outcomes were obtained from trial data. Publicly available pricing resources were used to supplement costs. Ranges for sensitivity analysis were based on 95% confidence intervals of the trial data. All costs were reported in 2020 Canadian dollars. This study was funded by a grant from the Canadian Institutes of Health Research.
Results
Trial data from 229 infants across six hospitals was included. Mean societal costs per patient were lower in the intermittent monitoring group: $6528 (95% CI: $3201, $12058) in the intermittent and $6815 (95% CI: $1454, $26485) in the continuous group with a mean incremental cost of -$287 (95% CI -$20084, $7842). Mean health care system costs per patient were $3992 (95% CI -$1139, $9224) in the intermittent and $4604 (95% CI -$317, $24126) in the continuous group (incremental cost -$613 (95% CI -$20564, $7089). The mean effect measure, length of stay, was also similar between the two groups: 36.3 hours in the intermittent group and 40.2 hours in the continuous group. One-way sensitivity analyses on all variables revealed that the findings were robust and the incremental costs were not sensitive to the uncertainty within the defined ranges.
Conclusion
In a prospective economic evaluation conducted with a clinical trial, we found that intermittent monitoring was less expensive than continuous monitoring, considering societal and health care costs. These findings support recommendations to use intermittent pulse oximetry monitoring in hospitalized infants with stabilized bronchiolitis.
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Affiliation(s)
- Myla E Moretti
- Ontario Child Health Support Unit-Clinical Trials Unit, The Hospital for Sick Children, Toronto, Ontario; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario
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7
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Yama B, Wahi G, Zhou K, Bayliss P, Sakran M, Breen-Reid K, Pound C, Beck C, Friedman J, Arafeh D, Kanani R, Parkin P, Mahant S. 76 Understanding practice change around intermittent versus continuous pulse oximetry in infants hospitalized with bronchiolitis: a multi-centre qualitative study. Paediatr Child Health 2022. [DOI: 10.1093/pch/pxac100.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract
Background
Bronchiolitis is the most common reason for hospitalization in infants and is cumulatively costly for the healthcare system. Trial evidence and national guidelines support the routine use of intermittent pulse oximetry in stabilized (no oxygen supplementation) infants with bronchiolitis. However, continuous pulse oximetry use is common.
Objectives
To understand the barriers and facilitators important to de-implementing continuous pulse oximetry and implementing intermittent pulse oximetry in stabilized infants hospitalized with bronchiolitis.
Design/Methods
From December 2018 to January 2020, participants were recruited from six Ontario hospitals (3 community and 3 paediatric hospitals) in a multi-centre qualitative study. Focus groups were conducted with staff paediatricians, paediatric residents, nurses, and respiratory therapists. Interviews were conducted with caregivers of infants recently hospitalized with bronchiolitis. Participants' beliefs, attitudes, and experiences related to pulse oximetry use in bronchiolitis management were explored. Recordings were transcribed and analyzed using thematic analysis via NVivo software to understand barriers and facilitators to practice change. These were then mapped to the domains and the constructs of the Consolidated Framework for Implementation Research (CFIR).
Results
67 individuals from six hospitals participated. Themes relevant to understanding barriers and facilitators to de-implementing continuous and implementing intermittent monitoring were identified. Healthcare professionals emphasized the importance of identifying and understanding who is responsible for bedside monitoring practice (physician vs. nurses). Clinical experience, knowledge of guidelines (international and local practice), importance relative to competing priorities, and the tensions amongst team members due to practice variation all influenced monitoring practice. Nurses held beliefs around the advantages of intermittent monitoring (e.g., reduced alarm fatigue, facilitation of timely discharges and reduced workload). Clinicians identified ways to clarify indications for ongoing continuous monitoring (e.g., based on clinical risk factors such as medical complexity, prematurity, and age), vs. indications to transition to intermittent monitoring (e.g., established oral feeding, sleeping without desaturations, and off supplemental oxygen). Caregivers did not express a clear preference for monitoring type, but described the stress of having a child admitted to hospital with an emphasis on the need for clear communication around the interpretation of monitors, management decisions, and care transitions.
Conclusion
In this multi-centre qualitative study of clinicians and caregivers, we identified barriers and facilitators that are important to de-implementing continuous monitoring and implementing intermittent monitoring. Understanding professional roles, clarity around local practice standards and supporting families' understanding of pulse oximetry monitoring practices are essential for practice change.
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Farrar D, Drouin O, Hepburn CM, Baerg K, Chan K, Cyr C, Donner E, Embree J, Farrell C, Forgie S, Giroux R, Kang K, King M, Laffin-Thibodeau M, Luu TM, Orkin J, Ouldali N, Papenburg J, Pound C, Price VE, Proulx-Gauthier JP, Purewal R, Sadarangani M, Salvadori M, Thibeault R, Top K, Viel-Thériault I, Kakkar F, Morris S. 50 Risk factors for severe COVID-19 in hospitalized children in Canada: A national prospective study from March 2020–May 2021. Paediatr Child Health 2022. [PMCID: PMC9586042 DOI: 10.1093/pch/pxac100.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Children living with chronic comorbid conditions are at increased risk for severe COVID-19 disease, though there is limited evidence regarding the risks associated with specific conditions and which children may benefit from targeted COVID-19 therapies. Age-specific baseline indicators of COVID-19 severity are also needed to evaluate the effectiveness of SARS-CoV-2 vaccination strategies in the paediatric population. Objectives In this study, we aimed to 1) identify factors associated with severe COVID-19 in children, and 2) describe rates of hospitalization, intensive care unit (ICU) admission, and severe COVID-19 within specific pediatric age groups. Design/Methods We conducted a national prospective study on hospitalized children with microbiologically confirmed SARS-CoV-2 infection via the Canadian Paediatric Surveillance Program from March 2020–May 2021. Cases were reported voluntarily by a network of >2800 paediatricians and paediatric subspecialists. SARS-CoV-2 hospitalizations were classified as COVID-19-related, incidental infection, or infection control/social admissions. Severe disease was defined as intensive care, ventilatory or hemodynamic requirements, select organ system complications, or death. Outcomes were described among children aged <6 months, 6–23 months, 2–4 years, 5–11 years, and 12–17 years. Risk factors for severe disease were identified using multivariable Poisson regression, adjusting for child age and sex, coinfections, and timing of hospitalization. Results We identified 541 children hospitalized with SARS-CoV-2 infection, including 329 (60.8%) with COVID-19-related disease. Median age at admission was 2.8 years (IQR 0.3-13.5) and 42.9% (n=232) had at least one comorbidity. Among COVID-19-related hospitalizations, severe disease occurred in 29.5% of children (n=97/329), including a higher proportion of children aged 2–4 years (48.7%) and 12–17 years (41.3%) (Table 1). Comorbidities associated with severe disease are described in Figure 1, and included technology dependence (adjusted risk ratio [aRR] 1.96, 95% confidence interval [CI] 1.31-2.95), neurologic conditions (e.g. epilepsy and chromosomal/genetic conditions) (aRR 1.87, 95% CI 1.34-2.61), and pulmonary conditions (e.g. bronchopulmonary dysplasia and uncontrolled asthma) (aRR 1.66, 95% CI 1.13-2.42). Conclusion While severe outcomes were detected at all ages and among patients with and without comorbidities, neurologic and pulmonary conditions as well as technology dependence were associated with increased risk of severe COVID-19. Children aged 2–4 years more commonly experienced severe COVID-19 in this study, which was conducted at a time when no children were eligible for SARS-CoV-2 vaccines. Notably, this high-risk group remains without access to approved vaccines. These findings may help guide vaccination programs and prioritize targeted COVID-19 therapies for children. ![]()
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Affiliation(s)
| | - Olivier Drouin
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine
| | | | | | | | - Claude Cyr
- Centre hospitalier universitaire de Sherbrooke
| | | | | | | | | | - Ryan Giroux
- St. Michael's Hospital, Unity Health Toronto
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9
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Gill PJ, Drouin O, Pound C, Quet J, Wahi G, Bayliss A, Vomiero G, Foulds J, Kanani R, Sakran M, Sehgal A, Pullenayegum E, Widjaja E, Reginald A, Wolter NE, Oni S, Anwar R, Cichon J, Louriachi H, Ge Y, Kirolos N, Patel A, Jasani H, Kornelsen E, Chugh A, Gouda S, Akbaroghli S, McKerlie M, Parkin PC, Mahant S. Factors Associated with Surgery and Imaging Characteristics in Severe Orbital Infections. J Pediatr 2022; 248:66-73.e7. [PMID: 35568061 DOI: 10.1016/j.jpeds.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/02/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate risk factors associated with surgical intervention and subperiosteal/orbital abscess in hospitalized children with severe orbital infections. STUDY DESIGN We conducted a multicenter cohort study of children 2 months to 18 years hospitalized with periorbital or orbital cellulitis from 2009 to 2018 at 10 hospitals in Canada. Clinical details were extracted, and patients were categorized as undergoing surgical or medical-only management. Primary outcome was surgical intervention and the main secondary outcome was clinically important imaging. Logistic regression was used to identify predictors. RESULTS Of 1579 patients entered, median age was 5.4 years, 409 (25.9%) had an orbital/subperiosteal abscess, and 189 (12.0%) underwent surgery. In the adjusted analysis, the risk of surgical intervention was associated with older age (age 9 to <14: aOR 3.9, 95% CI 2.3-6.6; and age 14 to ≤18 years: aOR 7.0, 95% CI 3.4-14.1), elevated C-reactive protein >120 mg/L (aOR 2.8, 95% CI 1.3-5.9), elevated white blood cell count of 12-20 000/μL (aOR 1.7, 95% CI 1.1-2.6), proptosis (aOR 2.6, 95% CI 1.7-4.0), and subperiosteal/orbital abscess (aOR 5.3, 95% CI 3.6-7.9). There was no association with antibiotic use before hospital admission, sex, presence of a chronic disease, temperature greater than 38.0°C, and eye swollen shut. Complications were identified in 4.7% of patients, including vision loss (0.6%), intracranial extension (1.6%), and meningitis (0.8%). CONCLUSIONS In children hospitalized with severe orbital infections, older age, elevated C-reactive protein, elevated white blood cell count, proptosis, and subperiosteal/orbital abscess were predictors of surgical intervention.
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Affiliation(s)
- Peter J Gill
- The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.
| | - Olivier Drouin
- Department of Pediatrics, Université de Montreal, Montreal, Quebec, Canada; Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Quebec, Canada
| | - Catherine Pound
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Julie Quet
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Gita Wahi
- Department of Pediatrics, McMaster University, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Ann Bayliss
- Trillium Health Partners, Department of Paediatrics, University of Toronto, Mississauga, Ontario, Canada
| | - Gemma Vomiero
- Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Jessica Foulds
- Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Ronik Kanani
- North York General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mahmoud Sakran
- Department of Paediatrics, Queens University, Lakeridge Health, Oshawa, Ontario, Canada; Research, Lakeridge Health, Oshawa, Ontario, Canada
| | - Anupam Sehgal
- Kingston Health Sciences Centre, Queens University, Kingston, Ontario, Canada
| | - Eleanor Pullenayegum
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Elysa Widjaja
- The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Arun Reginald
- The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus E Wolter
- The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Semipe Oni
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rashid Anwar
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jessica Cichon
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hossam Louriachi
- Department of Pediatrics, Université de Montreal, Montreal, Quebec, Canada
| | - Yipeng Ge
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Nardin Kirolos
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Ashaka Patel
- Department of Pediatrics, McMaster University, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Hardika Jasani
- Trillium Health Partners, Department of Paediatrics, University of Toronto, Mississauga, Ontario, Canada
| | - Emily Kornelsen
- Trillium Health Partners, Department of Paediatrics, University of Toronto, Mississauga, Ontario, Canada
| | - Ashton Chugh
- Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Sandra Gouda
- Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Susan Akbaroghli
- North York General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Morgyn McKerlie
- Kingston Health Sciences Centre, Queens University, Kingston, Ontario, Canada
| | - Patricia C Parkin
- The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Sanjay Mahant
- The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
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10
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Michaud-Létourneau I, Gayard M, Lauzière J, Beaudry M, Pascual LR, Chartier I, Herzhaft-LeRoy J, Chiasson S, Fontaine-Bisson B, Pound C, Gaboury I. Understanding the challenges related to breastfeeding education and barriers to curricular change: a systems perspective for transforming health professions education. Can Med Educ J 2022; 13:91-104. [PMID: 35875442 PMCID: PMC9297256 DOI: 10.36834/cmej.73178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES A majority of women and families wish that their babies be breastfed. However, too many still receive insufficient or inappropriate initial care from health professionals (HPs) who have limited breastfeeding (BF) competencies. We investigated barriers and potential solutions to improve the undergraduate training programs for various HPs. METHODS Focus groups were carried out in three universities in Quebec and one in Ontario (Canada), with 30 faculty and program directors from medicine, midwifery, nursing, nutrition, and pharmacy. Discussions were subjected to thematic content analysis, before being validated in a strategic planning workshop with 48 participants from the same disciplines, plus dentistry and chiropractic. FINDINGS Substantive improvements of undergraduate training programs for BF could be obtained by addressing challenges related to the insufficient, or lack of, (i) interactions among various HPs, (ii) opportunities for practical learning, (iii) specific standards to guide course content, (iv) real-life experience with counselling, and (v) understanding of the influence of attitudes on professional practice. Several potential solutions were proposed and validated. The re-interpretation of the results in light of various literature led to an emerging framework that takes a systems perspective for enhancing the education of HPs on BF. CONCLUSIONS To improve the education of HPs so as to enable them to provide relevant support for future mothers, mothers and their families, solutions need to be carried out to address challenges in the health system, the education system as well as regarding the curricular change process.
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Affiliation(s)
- Isabelle Michaud-Létourneau
- Mouvement allaitement du Québec, Québec, Canada
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Québec, Canada
- Département de médecine sociale et préventive, École de santé publique, Université de Montréal, Québec, Canada
| | | | - Julie Lauzière
- Mouvement allaitement du Québec, Québec, Canada
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Québec, Canada
| | | | | | - Isabelle Chartier
- Mouvement allaitement du Québec, Québec, Canada
- Faculté des sciences infirmières, Université de Montréal, Québec, Canada
| | | | | | - Bénédicte Fontaine-Bisson
- Mouvement allaitement du Québec, Québec, Canada
- School of Nutrition Sciences, University of Ottawa, Ontario, Canada
- Institut du savoir Montfort, Hôpital Montfort, Ontario, Canada
| | - Catherine Pound
- Department of Pediatrics, University of Ottawa, Ontario, Canada
| | - Isabelle Gaboury
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Québec, Canada
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11
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Pound C, Coyle D. A cost-utility analysis of the impact of electronic nicotine delivery systems on health care costs and outcomes in Canada. Health Promot Chronic Dis Prev Can 2022; 42:29-36. [PMID: 35044142 DOI: 10.24095/hpcdp.42.1.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION We determined the impact of electronic nicotine delivery systems (ENDS) on health outcomes and costs in Canada, based on their effect on smoking cessation and smoking initiation rates. METHODS We used gender-specific Markov models to estimate lifetime discounted life years, quality-adjusted life years (QALYs) and smoking-related health care costs for cohorts of males and females aged 15 to 19 years, in scenarios in which (1) ENDS are available (status quo); (2) ENDS are completely unavailable; and (3) ENDS are available for smoking cessation through health care provider prescription, in addition to currently recognized smoking cessation tools. Analysis was from the perspective of a publicly funded health care system. RESULTS Outcomes are expressed per 1000 individuals and based on expected values obtained through a Monte Carlo simulation of 10 000 replications. For males aged 15 to 19 years, life years, QALYs and smoking-related health care costs were 41 553, 35 871 and CAD 79 645 964, respectively, when ENDS were available; 41 568, 35 894 and CAD 79 645 960 when ENDS were unavailable; and 41 570, 35 897 and CAD 79 605 869 when ENDS were available through prescription only. For females, life years, QALYs and smoking-related health care costs were 43 596, 37 416 and CAD 69 242 856, respectively, when ENDS were available; 43 610, 37 438 and CAD 69 085 926 when ENDS were unavailable; and 43 611, 37 438 and CAD 69 076 034 when ENDS were available through prescription only. Thus, situations in which ENDS are unavailable, or available through prescription only are dominant over the status quo. CONCLUSION These results show that a policy change whereby ENDS were unavailable to the Canadian population or available through prescription only would likely increase population health and reduce health care costs.
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Affiliation(s)
- Catherine Pound
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Abstract
It is universally accepted that human milk is the optimal, exclusive source of nutrition for infants 0 to 6 months of age, and may remain part of the healthy infant diet for the first 2 years of age and beyond. Despite advances in infant formulas, human milk provides a wide range of benefits, due in part to its bioactive matrix that cannot be replicated by any other source of nutrition. When there is an insufficient volume of mother's milk for the vulnerable newborn, pasteurized donor human milk should be made available, as a bridge to mother's milk and as the first alternative feeding choice, followed by commercial formula. There is a limited supply of donor milk in Canada and distribution is prioritized for sick, hospitalized neonates. Informal milk sharing is the practice of donating and receiving expressed human milk without going through a human milk bank. Informal milk sharing carries risk for bacterial and viral transmission as well as inconsistency and uncertainty regarding donor screening. Paediatricians and other health care providers need to be aware of the risks of informal milk sharing and be able to counsel families appropriately on safer alternatives.
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Affiliation(s)
- Catherine Pound
- Canadian Paediatric Society, Nutrition and Gastroenterology Committee, Ottawa, Ontario
| | - Sharon Unger
- Canadian Paediatric Society, Nutrition and Gastroenterology Committee, Ottawa, Ontario
| | - Becky Blair
- Canadian Paediatric Society, Nutrition and Gastroenterology Committee, Ottawa, Ontario
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13
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Pound C, Unger S, Blair B. Les dons de lait humain pasteurisé et non pasteurisé. Paediatr Child Health 2020; 25:549-550. [DOI: 10.1093/pch/pxaa119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 09/10/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Il est universellement reconnu que le lait humain est la source de nutrition exclusive optimale pour les nouveau-nés de 0 à six mois et qu’il peut faire partie du régime du nourrisson en santé jusqu’à l’âge de deux ans et même après. Malgré les avancées dans le secteur des préparations lactées pour nourrisson, le lait humain apporte tout un éventail d’avantages, en partie grâce à sa matrice bioactive qu’aucune autre source d’alimentation ne peut reproduire. Lorsque la mère produit une quantité de lait insuffisante pour son nouveau-né vulnérable, du lait pasteurisé de donneuses devrait être rendu disponible pour compléter le lait maternel et être le premier choix proposé, suivi des préparations lactées commerciales. La quantité de lait de ce type est limitée au Canada, et sa distribution est priorisée auprès des nouveau-nés malades et hospitalisés. Le partage informel de lait humain consiste à donner et recevoir du lait humain exprimé sans passer par une banque de lait humain. Il comporte un risque de transmission de bactéries et de virus en plus d’être lié à des irrégularités et des incertitudes à l’égard du dépistage des donneuses. Les pédiatres et les autres dispensateurs de soins doivent connaître les risques du partage informel de lait humain et être en mesure de proposer des possibilités plus sécuritaires aux familles.
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Affiliation(s)
- Catherine Pound
- Société canadienne de pédiatrie, comité de nutrition et de gastroentérologie, Ottawa (Ontario)
| | - Sharon Unger
- Société canadienne de pédiatrie, comité de nutrition et de gastroentérologie, Ottawa (Ontario)
| | - Becky Blair
- Société canadienne de pédiatrie, comité de nutrition et de gastroentérologie, Ottawa (Ontario)
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Gill PJ, Parkin PC, Begum N, Drouin O, Foulds J, Pound C, Quet J, Vomiero G, Wahi G, Sakran M, Kozlowski N, Bayliss A, Kanani R, Sehgal A, Pullenayegum EM, Reginald A, Wolter N, Mahant S. Care and outcomes of Canadian children hospitalised with periorbital and orbital cellulitis: protocol for a multicentre, retrospective cohort study. BMJ Open 2019; 9:e035206. [PMID: 31871262 PMCID: PMC6937073 DOI: 10.1136/bmjopen-2019-035206] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Skin and soft tissue infections of the eye can be classified based on anatomic location as either anterior to the orbital septum (ie, periorbital cellulitis) or posterior to the orbital septum (ie, orbital cellulitis). These two conditions are often considered together in hospitalised children as clinical differentiation is difficult, especially in young children. Prior studies have identified variation in management of hospitalised children with orbital cellulitis; however, they have been limited either as single centre studies or by the use of administrative data which lacks clinical details important for interpreting variation in care. We aim to describe the care and outcomes of Canadian children hospitalised with periorbital and orbital cellulitis. METHOD AND ANALYSIS This is a multisite retrospective cohort study including previously healthy children aged 2 months to 18 years admitted to hospital with periorbital or orbital cellulitis from 2009 to 2018. Clinical data from medical records from multiple Canadian hospitals will be collected, including community and academic centres. Demographic characteristics and study outcomes will be summarised using descriptive statistics, including diagnostic testing, antibiotic therapy, adjunctive therapy, surgical intervention and clinical outcomes. Variation will be described and evaluated using χ² test or Kruskal-Wallis test. Generalised linear mixed models will be used to identify predictors of surgical intervention and longer length of stay. ETHICS AND DISSEMINATION Approval of the study by the Research Ethics Board at each participating site has been obtained prior to data extraction. Study results will be disseminated by presentations at national and international meetings and by publications in high impact open access journals. By identifying important differences in management and outcomes by each hospital, the results will identify areas where care can be improved, practice standardised, unnecessary diagnostic imaging reduced, pharmacotherapy rationalised and where trials are needed.
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Affiliation(s)
- Peter J Gill
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Nurshad Begum
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Olivier Drouin
- Department of Pediatrics, University of Montreal, Montreal, Québec, Canada
| | - Jessica Foulds
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine Pound
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Julie Quet
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Gemma Vomiero
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Gita Wahi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Mahmoud Sakran
- Department of Paediatrics, Queen's University, Oshawa, Ontario, Canada
| | - Natascha Kozlowski
- Research, Lakeridge Health Ajax Pickering Hospital, Ajax, Ontario, Canada
| | - Ann Bayliss
- Trillium Health Partners, University of Toronto, Mississauga, Ontario, Canada
| | - Ronik Kanani
- Department of Pediatrics, North York General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Anupam Sehgal
- Department of Paediatrics, Queen's University, Kingston, Ontario, Canada
| | - Eleanor M Pullenayegum
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Arun Reginald
- Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus Wolter
- Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology, University of Toronto, Toronto, Ontario, Canada
| | - Sanjay Mahant
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Jetty R, Harrison MA, Momoli F, Pound C. Practice variation in the management of children hospitalized with bronchiolitis: A Canadian perspective. Paediatr Child Health 2019; 24:306-312. [PMID: 31379431 DOI: 10.1093/pch/pxy147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/27/2018] [Indexed: 11/14/2022] Open
Abstract
Objectives To describe variations in the monitoring, treatment, and discharge of children hospitalized with bronchiolitis among physicians across Canadian paediatric teaching hospitals. Methods We conducted an electronic survey of paediatricians with experience in the management of inpatient bronchiolitis at 20 Canadian paediatric teaching hospitals. Only physicians who worked a minimum of 6 weeks on their hospital inpatient unit in the 2015 calendar year were eligible to participate in the study. The questionnaire explored the monitoring, treatment, and discharge of children with bronchiolitis. Central tendency (mean) and dispersion (SD) statistics were produced for continuous variables and frequency distributions for categorical variables. Results A total of 142 respondents were included in the analysis. 45.1% reported the routine use of continuous oxygen saturation monitoring. 27.5% used a higher cut-off for oxygen supplementation of 92% and 12.7% use a lower cut-off of 88%. 29.6% routinely used deep nasal suctioning. Seventy-three per cent reported using nebulized therapies. 55.6% reported having preprinted order sheets or guidelines for management of inpatient bronchiolitis at their institutions and 28.2% reported having specific discharge criteria. The length of time required to be off oxygen prior to discharge varied (31% at 12 hours, 27.5% at 24 hours, and 24.6% after the last sleep period without oxygen). Conclusion There is significant practice variation in the monitoring, treatment, and discharge of children hospitalized with bronchiolitis within and between Canadian paediatric teaching hospitals. Future research is needed to establish best practices, effective knowledge translation, and implementation strategies to standardize care and decrease length of stay.
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Affiliation(s)
- Radha Jetty
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Mary-Ann Harrison
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
| | - Franco Momoli
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
| | - Catherine Pound
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario
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Feldman M, Pound C. Sugary drinks and pediatric health: reflections from a tertiary care hospital. CMAJ 2018; 190:E993. [PMID: 30127042 PMCID: PMC6102108 DOI: 10.1503/cmaj.69949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Matthew Feldman
- Pediatrics resident, Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - Catherine Pound
- Pediatrician, Children's Hospital of Eastern Ontario, Ottawa, Ont
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Mahant S, Wahi G, Giglia L, Pound C, Kanani R, Bayliss A, Roy M, Sakran M, Kozlowski N, Breen-Reid K, Lavigne M, Premji L, Moretti ME, Willan AR, Schuh S, Parkin PC. Intermittent versus continuous oxygen saturation monitoring for infants hospitalised with bronchiolitis: study protocol for a pragmatic randomised controlled trial. BMJ Open 2018; 8:e022707. [PMID: 29678995 PMCID: PMC5914772 DOI: 10.1136/bmjopen-2018-022707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Bronchiolitis is the most common reason for hospitalisation in infants in developed countries. The main focus of hospital care is on supportive care, such as monitoring for hypoxia and supplemental oxygen administration, as active therapies lack effectiveness. Pulse oximetry is used to monitor hypoxia in hospitalised infants and is used either intermittently or continuously. Observational studies have suggested that continuous pulse oximetry use leads to a longer length of hospital stay in stable infants. The use of continuous pulse oximetry may lead to unnecessary clinical intervention due to readings that are of little clinical significance, false-positive readings and less reliance on the clinical status. There is a lack of high-quality evidence to guide which pulse oximetry monitoring strategy, intermittent or continuous, is superior in infants hospitalised with bronchiolitis with respect to patient and policy-relevant outcomes. METHODS AND ANALYSIS This is a multicentre, pragmatic randomised controlled trial comparing two strategies for pulse oximetry monitoring in infants hospitalised for bronchiolitis. Infants aged 1 month to 2 years presenting to Canadian tertiary and community hospitals will be randomised after stabilisation to receive either intermittent or continuous oxygen saturation monitoring on the inpatient unit until discharge. The primary outcome is length of hospital stay. Secondary outcomes include additional measures of effectiveness, acceptability, safety and cost. We will need to enrol 210 infants in order to detect a 12-hour difference in length of stay with a type 1 error rate of 5% and a power of 90%. ETHICS AND DISSEMINATION Research ethics approval has been obtained for this trial. This trial will provide data to guide hospitals and clinicians on the optimal pulse oximetry monitoring strategy in infants hospitalised with bronchiolitis. We will disseminate the findings of this study through peer-reviewed publication, professional societies and meetings. TRIAL REGISTRATION NUMBER NCT02947204.
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Affiliation(s)
- Sanjay Mahant
- Division of Paediatric Medicine, Paediatric Outcomes Research Team (PORT), Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Research Institute, Hospital for Sick Children, Hamilton, Ontario, Canada
| | - Gita Wahi
- Department of Pediatrics, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Lucy Giglia
- Department of Pediatrics, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Catherine Pound
- Department of Paediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Ronik Kanani
- Department of Paediatrics, North York General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ann Bayliss
- Trillium Health Partners, Department of Paediatrics, University of Toronto, Mississauga, Ontario, Canada
| | - Madan Roy
- Department of Pediatrics, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Mahmoud Sakran
- Department of Paediatrics, Queens University, Lakeridge Health, Oshawa, Ontario, Canada
| | | | - Karen Breen-Reid
- Interprofessional Education, Learning Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Mollie Lavigne
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Laila Premji
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Myla E Moretti
- Clinical Trials Unit-Ontario Child Health Support Unit, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrew R Willan
- Dalla Lana School of Public Health, Ontario Child Health Support Unit, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Suzanne Schuh
- Division of Emergency Medicine, Department of Paediatrics, University of Toronto Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Division of Paediatric Medicine, Paediatric Outcomes Research Team (PORT), Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Research Institute, Hospital for Sick Children, Hamilton, Ontario, Canada
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Abstract
BACKGROUND Adherence to Baby Friendly Initiative (BFI) practices is low in Canadian hospitals, despite evidence showing a positive impact of BFI practices on breastfeeding rates and duration. In 2012, the provincial Ontario Ministry of Health and Long Term Care added BFI status to its progress indicators for Public Health Units, which are now required to begin BFI implementation. OBJECTIVE This study aims to explore health care workers' self-reported knowledge of the BFI and their perceptions of the importance of its components. METHODS A questionnaire was electronically sent to 2237 employees working at our institution. RESULTS Questionnaires were completed by 651 participants, of which 110 (16.9%) and 87 (13.5%) participants reported having good knowledge of the BFI and the Ten Steps to Successful Breastfeeding, respectively. Multiple logistic regression showed that having children and having received formal breastfeeding education were associated with higher self-reported knowledge. Additionally, 481 (75%) participants reported that it was important or very important to them that the institution adopt the BFI. Having children and being an allied health professional were associated with perceiving the implementation of the BFI as important. CONCLUSION The results of our study have allowed us to identify potential barriers to implementation of the BFI, which can be targeted through system changes and staff education. Through this approach, we hope to facilitate acceptance of the BFI at our institution and increase support for optimal breastfeeding practices among our patients.
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Affiliation(s)
- Catherine Pound
- 1 Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Natalie Ward
- 2 School of Sociological and Anthropological Studies, University of Ottawa, Canada
| | | | - Salwa Akiki
- 4 Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Jason Chan
- 4 Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Stuart Nicholls
- 5 Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
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19
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Laliberté C, Dunn S, Pound C, Sourial N, Yasseen AS, Millar D, Rennicks White R, Walker M, Lacaze-Masmonteil T. A Randomized Controlled Trial of Innovative Postpartum Care Model for Mother-Baby Dyads. PLoS One 2016; 11:e0148520. [PMID: 26871448 PMCID: PMC4752489 DOI: 10.1371/journal.pone.0148520] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 01/18/2016] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the efficacy, safety, and maternal satisfaction of a newly established integrative postpartum community-based clinic providing comprehensive support for mothers during the first month after discharge from the hospital. Our primary interests were breastfeeding rates, readmission and patient satisfaction. Methods A randomized controlled trial was conducted in Ottawa, Canada, where 472 mothers were randomized via a 1:2 ratio to either receive standard of care (n = 157) or to attend the postpartum breastfeeding clinic (n = 315). Outcome data were captured through questionnaires completed by the participants at 2, 4, 12 and 24 weeks postpartum. Unadjusted and adjusted logistic regression models were conducted to determine the effect of the intervention on exclusive breastfeeding at 12 weeks (primary outcome). Secondary outcomes included breastfeeding rate at 2, 4 and 24 weeks, breastfeeding self-efficacy scale, readmission rate, and satisfaction score. Results More mothers in the intervention group (n = 195, 66.1%) were exclusively breastfeeding at 12 weeks compared to mothers in the control group (n = 81, 60.5%), however no statistically significant difference was observed (OR = 1.28; 95% CI:0.84–1.95)). The rate of emergency room visits at 2 weeks for the intervention group was 11.4% compared to the standard of care group (15.2%) (OR = 0.69; 95% CI: 0.39–1.23). The intervention group was significantly more satisfied with the overall care they received for breastfeeding compared to the control group (OR = 1.96; 95% CI: 3.50–6.88)). Conclusion This new model of care did not significantly increase exclusive breastfeeding at 12 weeks. However, there were clinically meaningful improvements in the rate of postnatal problems and satisfaction that support this new service delivery model for postpartum care. A community-based multidisciplinary postpartum clinic is feasible to implement and can provide appropriate and highly satisfactory care to mother-baby dyads. This model of care may be more beneficial in a population that is not already predisposed to breastfeed. Trial Registration ClinicalTrials.gov NCT02043119
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Affiliation(s)
- Corinne Laliberté
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Sandra Dunn
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Better Outcomes Registry & Network Ontario, Ottawa, Ontario, Canada
| | - Catherine Pound
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Paediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Nadia Sourial
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Abdool S. Yasseen
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Better Outcomes Registry & Network Ontario, Ottawa, Ontario, Canada
| | - David Millar
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ruth Rennicks White
- Obstetrics and Maternal Newborn Investigations, the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mark Walker
- Obstetrics and Maternal Newborn Investigations, the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Thierry Lacaze-Masmonteil
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Paediatrics, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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20
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Stevens A, Hamel C, Singh K, Ansari MT, Myers E, Ziegler P, Hutton B, Sharma A, Bjerre LM, Fenton S, Gow R, Hadjiyannakis S, O’Hara K, Pound C, Salewski E, Shrier I, Willows N, Moher D, Tremblay M. Do sugar-sweetened beverages cause adverse health outcomes in children? A systematic review protocol. Syst Rev 2014; 3:96. [PMID: 25192945 PMCID: PMC4160918 DOI: 10.1186/2046-4053-3-96] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 08/22/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Cardiovascular disease and type 2 diabetes are examples of chronic diseases that impose significant morbidity and mortality in the general population worldwide. Most chronic diseases are associated with underlying preventable risk factors, such as elevated blood pressure, high blood glucose or glucose intolerance, high lipid levels, physical inactivity, excessive sedentary behaviours, and overweight/obesity. The occurrence of intermediate outcomes during childhood increases the risk of disease in adulthood. Sugar-sweetened beverages are known to be significant sources of additional caloric intake, and given recent attention to their contribution in the development of chronic diseases, a systematic review is warranted. We will assess whether the consumption of sugar-sweetened beverages in children is associated with adverse health outcomes and what the potential moderating factors are. METHODS/DESIGN Of interest are studies addressing sugar-sweetened beverage consumption, taking a broad perspective. Both direct consumption studies as well as those evaluating interventions that influence consumption (e.g. school policy, educational) will be relevant. Non-specific or multi-faceted behavioural, educational, or policy interventions may also be included subject to the level of evidence that exists for the other interventions/exposures. Comparisons of interest and endpoints of interest are pre-specified. We will include randomized controlled trials, controlled clinical trials, interrupted time series studies, controlled before-after studies, prospective and retrospective comparative cohort studies, case-control studies, and nested case-control designs. The MEDLINE®, Embase, The Cochrane Library, CINAHL, ERIC, and PsycINFO® databases and grey literature sources will be searched. The processes for selecting studies, abstracting data, and resolving conflicts are described. We will assess risk of bias using design-specific tools. To determine sets of confounding variables that should be adjusted for, we have developed causal directed acyclic graphs and will use those to inform our risk of bias assessments. Meta-analysis will be conducted where appropriate; parameters for exploring statistical heterogeneity and effect modifiers are pre-specified. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach will be used to determine the quality of evidence for outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014009641.
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Affiliation(s)
- Adrienne Stevens
- Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON K1H 8L6, Canada
| | - Candyce Hamel
- Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON K1H 8L6, Canada
| | - Kavita Singh
- University of Ottawa, 30 Marie Curie Street, Ottawa K1N 6N5, Canada
| | - Mohammed T Ansari
- Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON K1H 8L6, Canada
| | - Esther Myers
- E F Myers Consulting Inc, 600 North Oak Street, Trenton, IL 62293, USA
| | - Paula Ziegler
- Research Evidence Analysis, Academy of Nutrition and Dietetics, 120 South Riverside Plaza, Suite 2000, Chicago, IL 60606, USA
| | - Brian Hutton
- Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON K1H 8L6, Canada
| | - Arya Sharma
- Canadian Obesity Network, Royal Alexandra Hospital, MMC, Room 102, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9, Canada
| | - Lise M Bjerre
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Department of Family Medicine, University of Ottawa, 43 Bruyere Street, Annex E, Room 206, Ottawa, ON K1N 5C8, Canada
| | - Shannon Fenton
- Planning, Research and Analysis Branch, Ministry of Health and Long-Term Care, 80 Grosvenor Street, 8th Floor, Hepburn Block, Toronto, ON M7A 1R3, Canada
| | - Robert Gow
- Division of Cardiology, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | - Stasia Hadjiyannakis
- Division of Endocrinology, Department of Pediatrics and Department of Medicine, University of Ottawa, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | - Kathryn O’Hara
- School of Journalism and Communication Journalism, Carleton University, 4th Floor River Building, 1125 Colonel By Drive, Ottawa, ON K1S 5B6, Canada
| | - Catherine Pound
- Division of Pediatric Medicine, Children's Hospital of Eastern Ontario and Department of Medicine, University of Ottawa, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | - Erinn Salewski
- Healthy Living Section, Chronic Disease and Injury Prevention, Ottawa Public Health, 100 Constellation Drive, 7th Floor East (26-42), Ottawa, ON K2G 6J8, Canada
| | - Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, 3755 Cote Sainte-Catherine Road, Montreal, QC H3T 1E2, Canada
| | - Noreen Willows
- Department of Agricultural, Food and Nutritional Science, University of Alberta, 4-378 Edmonton Clinic Health Academy, Mailbox #54, 11405 87 Avenue, Edmonton, AB T6G 2P5, Canada
| | - David Moher
- Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON K1H 8L6, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, 501 Smyth Road, Box 201B, Ottawa, ON K1H 8L6, Canada
| | - Mark Tremblay
- Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
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Pound C, Moreau K, Rohde K, Farion K, Barrowman N, Aglipay M, Plint AC. 172: The Impact of a Breastfeeding Support Intervention on Breastfeeding Duration in Jaundiced Infants Admitted to a Tertiary Care Centre Hospital: A Randomized Controlled Trial. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pound C, Lindsay E, Plint AC, Moreau K. 140: A Study of the Impact of Continuing Professional Development (CPD) Activities on Physicians' Knowledge, Motivation and Ability to Address Challenges with Exclusive Breastfeeding Practices. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pound C, Williams K, Grenon R, Aglipay M, Plint AC. 139: Breastfeeding Knowledge, Confidence, Beliefs and Attitudes of Canadian Physicians. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dave B, Gatlin J, Pound C, McCowan T. Abstract No. 130: MRI-guided cryoabaltion of 110 patients with solid renal tumors. J Vasc Interv Radiol 2011. [DOI: 10.1016/j.jvir.2011.01.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Katz RC, Hallowell B, Code C, Armstrong E, Roberts P, Pound C, Katz L. A multinational comparison of aphasia management practices. Int J Lang Commun Disord 2000; 35:303-314. [PMID: 10912257 DOI: 10.1080/136828200247205] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The effect of restructuring of healthcare on the quality, quantity, and nature of aphasia management is largely unknown. The current study is the first to examine access, diagnostic, treatment, and discharge patterns of patients with aphasia in Australia, Canada, the UK, the US private sector (US-Private), and the US Veterans Health Administration in the Department of Veterans Affairs (US-VA). The authors developed a 37-item survey to be completed by clinicians working with aphasic patients. The survey focused on eight areas: access to care, evaluation procedures, group treatment, number and duration of treatment sessions, limitations of the number of sessions, termination of treatment, follow-up practices, and resumption of treatment. 394 surveys were distributed and 175 were returned completed (44% return rate). Respondents represented a range of ages, work experiences, and work settings. There was considerable consistency among respondents from our five healthcare systems. Results suggest that patients may be routinely denied treatment in direct contradiction to the research literature. Just as we carefully monitor the progress of patients receiving our treatment, we are obliged to monitor the effects of managed care on our patients, fellow clinicians, and our profession.
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Affiliation(s)
- R C Katz
- Audiology and Speech Pathology Department (CS/126), Carl T. Hayden VA Medical Center, Phoenix, AZ 85012-1892, USA.
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Abstract
This paper reports a therapy study that aims to promote communicative drawing in a group of seven people with severe and long-standing aphasia. Therapy was conducted on individual and group bases over 12 weeks and entailed a range of techniques which are described in some detail. Treatment was evaluated using a novel generative drawing assessment in which subjects were required to draw absent items in response to photographic and conversational cues. Pre- and post-therapy assessments of untreated skills, such as comprehension, naming and gesture, were also conducted. The results indicated that, as a group, the subjects' drawing improved. Unchanged performance on the other assessments indicated that the gains were specific to the content of therapy and could not be attributed to spontaneous recovery. Pre- and post-therapy interviews with carers (i.e. relatives and close friends of the individuals) suggested that the effects of therapy were also being felt in the home. These results have important implications for therapy with people with severe aphasia.
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Affiliation(s)
- C Sacchett
- St Peter's Hospital, Bournewood NHS Trust, Chertsey, UK
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